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Individual

MRS. THERESA BUCKLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
APRN, CNM

Contact information

Practice address
1265 VISCAYA PKWY, CAPE CORAL, FL 33990-3237
(239) 574-2229
(239) 574-2762
Mailing address
12730 NEW BRITTANY BLVD STE 602, FORT MYERS, FL 33907-4690
(239) 275-5522
(239) 275-4464

Taxonomy

Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
APRN3194502
FL
367A00000X
Advanced Practice Midwife
Primary
APRN3194502
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001180900
FL
01
Y02ET
BCBSFL
FL
Enumeration date
07/27/2006
Last updated
11/21/2018
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